<br>
<center><font size="4"><b style="color: blue;">Welcome,	Fill this admission form to create student profile</b></font></center>

<form name="studentAdmissionForm" action="action.admin?cmd=#" method="post">
<table cellpadding="5" align="center">

		<tr><td style="color: red; text-align: center;" colspan="2">(Star Marked fields are Mandatory)</td></tr>
		<tr><td><label style="color: red;">*</label>Reference No:</td><td><input type="text" size="20" name="ref_no" id="sname" /></td></tr>
		<tr><td><label style="color: red;">*</label>First Name:</td><td><input type="text" size="20" name="name1" id="sname" /></td></tr>
		<tr><td><label style="color: red;">*</label>Last Name:</td><td><input type="text" size="20" name="name2" id="sname" /></td></tr>
		<tr><td><label style="color: red;">*</label>Date of Birth:<br>&nbsp;&nbsp;(DD-MM-YYYY)</td><td><input type="text" size="20" name="dob" id="dob" /></td></tr>	
		<tr><td><label style="color: red;">*</label>Gender:</td>
										<td><input type="radio" name="gender" value="male"/>Male
											<input type="radio" name="gender" value="female"/>Female
										</td>
		<tr><td><label style="color: red;">*</label>Blood Group:</td><td><input type="text" size="20" name="bg"/></td></tr>
		<tr><td><label style="color: red;">*</label>Category:</td>
										<td>
											<select	name="category" size="1" style="width: 20">
												<option selected value="Category">Select</option>
												<option>General</option>
												<option>SC</option>
												<option>ST</option>
												<option>OBC</option>
											</select>
										</td>
		<tr><td>&nbsp;&nbsp;Religion:</td><td><input type="text" size="20" name="religion"/></td></tr>
		<tr><td><label style="color: red;">*</label>Father's Name:</td><td><input type="text" size="20" name="fname"/></td></tr>
		<tr><td><label style="color: red;">*</label>Mother's Name:</td><td><input type="text" size="20" name="mname"/></td></tr>
		<tr><td><label style="color: red;">*</label>Father's Occupation:</td><td><input type="text" size="20" name="fjob"/></td></tr>
		<tr><td><label style="color: red;">*</label>Mother's Occupation:</td><td><input type="text" size="20" name="mjob"/></td></tr>
		<tr><td><label style="color: red;">*</label>Address Line1:</td><td><input type="text" size="20" name="address1"/></td></tr>	
		<tr><td><label style="color: red;">*</label>Address Line2:</td><td><input type="text" size="20" name="address2"/></td></tr>	
		<tr><td><label style="color: red;">*</label>City:</td><td><input type="text" size="20" name="city" /></td></tr>	
		<tr><td><label style="color: red;">*</label>State:</td><td><input type="text" size="20" name="state" /></td></tr>	
		<tr><td><label style="color: red;">*</label>Pin Code:</td><td><input type="text" size="20" name="pin_code" /></td></tr>	
		<tr><td><label style="color: red;">*</label>Contact No:</td><td><input type="text" size="20" name="contact" id="contact" /></td></tr>		
		<tr><td>&nbsp;&nbsp;E-mail:</td><td><input type="text" size="20" name="email" id="email" /></td></tr>	
		
		<tr><td colspan="2" style="text-align: center;">
					<input type="submit" value="Submit" align="middle">
					<input type="reset" value="Reset" align="middle">
			</td>
		</tr>
</table>
</form>